Most infants in the neonatal intensive care unit (NICU) are not able to breastfeed effectively. Instead, either the infant is bottle fed, or breastmilk or formula is delivered through an orogastric or nasogastric passage to the infant's stomach. In these situations, breastmilk is expressed from the mother and stored in a freezer or refrigerator until it is desired for use, at which point it is often transferred to bottles or syringes for delivery to the baby.
Because infants in the NICU have difficulty maintaining their body temperature, the breastmilk or formula is warmed prior to feeding so the chill will not stress the infant. The current practice for warming breastmilk or formula is for nurses to place the bottles in warm water baths. The water in the warm water baths is typically supplied from sink faucets. Depending on the hot water settings, distance of the NICU from the water heater, and other variables, the temperatures of the warm water can vary greatly. The temperatures of the warm water can also vary depending on how long the nurses wait for the water to reach its maximum temperature before filling the baths. The actual water temperature is not measured, and the actual temperature of the milk in the bottle is unknown.
The breastmilk is typically thawed using one of several methods: thawing for more than 24 hours in a refrigerator at 4° C., setting the liquid out for an undetermined number of hours on a counter at room temperature and then placing it in a refrigerator, or a rapid thaw may be performed in which the protocol used for thawing and warming with water is employed to frozen milk in order to accelerate the thawing rate. This protocol is an uncontrolled method in which the damage that has potentially been done to the milk as a result of the temperature and rate times that are employed is unknown.
Additionally, the prevention of the spreading of germs is critical in this environment, as infants in the NICU are very fragile and susceptible to infection. The risk of warming a bottle or syringe using water that is not sterile and contains some level of bacteria exists. This water could leak into the bottle or syringe and contaminate the liquid within, aid transfer of germs through handling of the water and containers, and provide a media for further bacterial growth. This is a known potential of contamination within the majority of hospitals. Just using water as a temperature adjustment medium is considered undesirable.
The fact that water is used to heat the bottles and the bottles are then often carried to the baby's bed may also result in water damage to bedside charts and computers.
It is desirable to have an apparatus that can repeatedly warm and thaw breastmilk or formula to an appropriate temperature without detrimentally affecting the breastmilk composition in order to prevent stressing the infant and eliminating the risk of potential contamination sites. Conversely, it would be desirable for the same apparatus to further have a cooling (or refrigeration) aspect as well.
It is also desirable to perform these tasks as quickly as possible, given the time constraints and workload imposed upon neonatal nurses. Nurses usually state it takes them approximately 15 minutes for the total warming process for breastmilk. Considering that this task is repeated six to eight times a day, it can accumulate to a considerable amount of time and labor cost for a facility.
It is also desirable to have an apparatus that can handle all manner of devices that may be used to contain the breastmilk, such as syringes, bottles, jars, bags and other containers.